1982, 06-02 Permit: 82A-4432 Re-RoofPLAN NUMBER
APPLICATION/PERMIT
SPOKANE COUNTY — BUILDING CODES DEPARTMENT
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
JOB ADDRESS
LOT L • 12.01 )2,—T-14
BLOCK
SUBDIVISION
2.
OWNER
3. RALPtF k E LL.
ADDRESS
LEGAL DESCRIPTION - SEE ATTACHED
PARCEL NUMBER/S
PHONE
524 -z z
!ZC 115 12. -rt4 AVE.
ZIP
992o‘
Actual Set Backs in Feet
North (South [East 'West
CONTRACTOR
4. SWN
ADDRESS
PHONE
Size of Parcel 1 Zone Classification
ZIP
Type Const.
Occupancy
Sprinklered
❑Yes ❑No ❑ Req'd.
DESIGNER
5. ADDRESS
PHONE
Valuation 1 Building Area in Sq. Ft.
ZI P
Main Floor
Upper Floors
Garage Area
Storage
CHANGE OF USE FROM
6.
TO
Area of Decks
Finished Basement
Unfin. Basement
TYPE
7. OF
WORK
❑ NEW
❑ BLD.
❑ ALT.
❑ PLMB.
❑ AD'N.
❑ MECH.
❑ RPL.
❑ M.H.
❑ MVE.
❑ POOL
1=YOTHER
No. Baths
No. Stories
No. Rooms
No. of Dwellings
CERTIFICATE
of EXEMPTION
Req'd.
Rec'd.
Not Req'd.
DESCRIBE WORK
8. P'e- }AGF
VALUATION
s. /0Op
XtS C71VC. R'Sip€N1C'g-
GAS
SOURCE
OF
UTILITIES
ELECTRIC
Enum. Dist.
ILocation (Area)
WATER
SEWER
Ownership
Public ❑ Private ❑
USE CODE
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included
on reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this
type of work will be complied with whether specified herein or not. The granting of a permit does not presume
to give authority to violate or cancel the provisions of any other state or local law regulating construction or the
performance of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
—rn/24 _k2a12/14/
/ v
DATE OF APPLICATION SIGNATURE OF APPLICANT
SPECIAL APPROVALS SPECIAL CONDITIONS:
NAME DATE
Env. Health
Planning
Fire Marshall
Co. Engineer
Utilities
Plans Examiner
SEPA Checklist
Building Technician
PERMIT IS NONTRANSFERABLE
FEES COLLECTED
Single $
Building Ze1QC
Plumbing
Mech.
Plan Check
SEPA
Mobile Home
Other (Specify)
TOTAL
$ �w
PERMIT NUMBER
02* *2000
*2000 I~I)
44.31
06-02-82
s 6479.
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
0;60:2=82{ 443,22 *20.00°
PERMIT EXPIRES ONE YEAR FROM DATE OF ISSUANCE DATE ISSUFn
PERMIT r\lfl T(1T0I